MINUTES OF THE SENATE COMMITTEE ON COMMERCE AND LABOR Sixty-eighth Session June 12, 1995 The Senate Committee on Commerce and Labor was called to order by Chairman Randolph J. Townsend, at 5:00 p.m., on Monday, June 12, 1995, in Room 227 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Attendance Roster. COMMITTEE MEMBERS PRESENT: Senator Randolph J. Townsend, Chairman Senator Ann O'Connell, Vice Chairman Senator Sue Lowden Senator Kathy M. Augustine Senator Raymond C. Shaffer Senator John B. (Jack) Regan Senator Joseph M. Neal, Jr. STAFF MEMBERS PRESENT: Scott Young, Senior Research Analyst Molly Dondero, Committee Secretary OTHERS PRESENT: Lisa Adams, Executive Secretary, Board of Examiners for Social Workers Bobbie Gang, Lobbyist, National Association of Social Workers, Nevada Chapter Robert F. Martin, Lobbyist, Executive Director, Nevada Association of Homeopathic Physicians Marsha Berkbigler, Lobbyist, Nevada State Medical Association Sharn Weaver, Supervisor, Life and Health, Division of Insurance Robert Barengo, Lobbyist, Humana Health Insurance of Nevada, Inc. The work session was opened on Assembly Bill (A.B.) 477 with a discussion of Exhibit C. ASSEMBLY BILL 477: Makes various changes relating to social workers. Lisa Adams, Executive Secretary, Board of Examiners for Social Workers, discussed the board's methods for saving operating costs. She explained the need for fee increases to better serve the public. She stated the board wishes to create a brochure for consumers to alert them to the work of the board. The brochure will also explain the function of the board. Senator Townsend asked if the social workers are aware of the requested fee increases. Bobbie Gang, Lobbyist, National Association of Social Workers, Nevada Chapter, responded the social workers are fully in support of the bill and agree that the fee increases are necessary. Senator Townsend commented on the budget listing in Exhibit C. He stated the distribution of fees is 55 percent-45 percent, consumers vs. licensees. He asked if the consumer is going to see a benefit from the fee increases. Ms. Adams stated the consumers will benefit a great deal by understanding their rights and the duties of the board. SENATOR REGAN MOVED TO DO PASS A.B. 477. SENATOR NEAL SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR AUGUSTINE VOTED NO.) ***** The work session was closed on A.B. 477 and opened on A.B. 488. ASSEMBLY BILL 488: Revises provisions governing regulation of accountants. SENATOR LOWDEN MOVED TO DO PASS A.B. 488. SENATOR O'CONNELL SECONDED THE MOTION. THE MOTION CARRIED UNANIMOUSLY. ***** The work session was closed on A.B. 488 and opened on Senate Bill (S.B.) 537. SENATE BILL 537: Makes various changes to provisions relating to physicians. Robert F. Martin, Lobbyist, Executive Director, Nevada Association of Homeopathic Physicians, discussed Exhibit D. He stated the association has agreed to strike section 1 of the bill deleting lines 6 through 9. He stated on section 2, lines 13 and 14, they will delete "or Great Britain," line 25, and delete "its equivalent" and replace with "Doctor of Osteopathic Medicine." Marsha Berkbigler, Lobbyist, Nevada State Medical Association, stated she wished a comment made by Dr. Frank Nemic, President of the Nevada State Medical Association, to be placed on record. "We want all the amendments made. It does not put us in a position of being in support of the legislation, but we will certainly . . . we will fence walk it." Senator Townsend asked if Ms. Berkbigler has discussed subsection 2 on page 2 of the bill. He asked how it applies to what the board of medical examiners does for medical doctors. Ms. Berkbigler responded it is similar in some respects. Senator Townsend stated the board needs to address the issue with the Board of Medical Examiners to set up language to make the requirements equal. Ms. Berkbigler stated the association will be very happy to participate in any discussions if they are asked. SENATOR O'CONNELL MOVED TO AMEND AND DO PASS S.B. 537. SENATOR REGAN SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR AUGUSTINE VOTED NO.) ***** The work session was closed on S.B. 537 and opened on S.B. 492. SENATE BILL 492: Makes various changes relating to homeopathy. Mr. Martin discussed Exhibit E. Mr. Martin stated there is an additional recommendation made by the board's attorney from the attorney general's office to be added to Exhibit E. He stated the section 9, subsection 2 should read "to the district court" rather than "to the board." Ms. Berkbigler stated she has not been involved in this bill, bu t in th e or ig in al he ar in g sh e un de rs to od th e ho me op at hi c as si st an t wo ul d co mp ar e to th e ph ys ic ia n' s as si st an t. Sh e po in te d ou t no w th at th e ph ys ic ia n' s as si st an t is al lo we d to pr es cr ib e co nt ro ll ed su bs ta nc es , li ne 23 of se ct io n 5 al lo ws th e ho me op at hi c as si st an t to do th e sa me . Sh e st at ed th e ph ys ic ia n' s as si st an ts ar e ti ed di re ct ly to th e do ct or s fo r wh om th ey wo rk . Sh e su gg es te d fi ve as si st an ts wh o ar e ad mi ni st er in g co nt ro ll ed su bs ta nc es ar e to o ma ny to su pe rv is e. Mr. Martin explained that is not the intent of the bill. He stated the request is for prescribing homeopathic medicines only, not controlled substances. Senator Townsend stated the language must be clarified so the homeopathic assistant is not prescribing controlled substances. Ms. Berkbigler suggested using the phrase "homeopathic pharmacopeia" on line 23 of section 5. Mr. Martin suggested the language be placed on page 2, line 1 to read "substances used in the homeopathic pharmacopeia of the United States." SENATOR SHAFFER MOVED TO AMEND AND DO PASS S.B. 492. SENATOR NEAL SECONDED THE MOTION. THE MOTION CARRIED. (SENATOR AUGUSTINE VOTED NO.) ***** The work session was closed on S.B. 492 and opened on S.B. 196. SENATE BILL 196: Prohibits certain insurance coverages from excluding coverage for certain treatment provided by homeopathic physicians. Senator Townsend discussed Exhibit F with Sharen Weaver, Supervisor, Life and Health, Division of Insurance. Ms. Weaver commented on Senator Townsend's statement that S.B. 196 originally mandated that all policies of health insurance will cover homeopathy. Senator Townsend stated Exhibit F deletes the original bill and replaces it with new language. Ms. Weaver stated the self-insured is not covered in the bill under the federal law, Employers Retirement Income Security Act of 1974 (ERISA). She commented self-funded plans are not affected. Mr. Martin stated the provisions which are most significant are on page 2 of Exhibit F. He stated as long as the service is within the scope of the license of the person providing the treatment, the doctor should be paid for that service. Senator Townsend asked what is the difference between the language in S.B. 196 and Exhibit F. Mr. Martin explained the original version mandated more than what is contained in health insurance policies. He stated the bill is intended to provide that patients may select whatever physician they want, who is qualified to provide the treatment. He stated if there is an exclusion in a policy for homeopathy, the patient may not go to a homeopathic physician and expect treatment, but if there is no exclusion, the doctor may be paid for services rendered. Mr. Martin stated the way the language was drafted in the original bill, the policy must cover homeopathic medicine. Senator Townsend asked if the bill passes how will it affect premiums of a health care policy. Ms. Weaver stated the language does not discuss any "willing provider." She stated it does not negate the right to have a preferred provider organization (PPO) plan or a right to have a health management organization (HMO) closed panel network. She stated if it affects "any willing provider," then it may affect 28 percent of the premiums. She stated the language does not do that. It does codify a regulation and makes certain there is no discrimination against treatment rendered by doctor's of homeopathic medicine. She stated regulations have the same force as the law and she is not aware of any situation in which the insurance division has allowed a licensed insurer to specifically exclude or discriminate against a doctor of homeopathy. Robert Barengo, Lobbyist, Humana Health Insurance of Nevada, Inc., pointed out health management organizations are not excluded in the language of Exhibit F. Mr. Barengo pointed out that the language in section 3, subsection b will require paying a midwife the same amount as for a doctor. He stated there is no allowance for differentiation in the rates. Ms. Weaver commented she had not seen this language and would like the opportunity to review the newer amendment (Exhibit F). She pointed out that one sentence, "reimbursing different amounts" refers to any willing provider. She stated in the regulation there are exclusions for HMOs and PPOs. She commented the language, as written will call for repeal of PPO and HMO laws and amendments to Nevada Revised Statutes (NRS) 689A.380. Mr. Barengo read the regulation in the statute. Senator Townsend commented section 1, subsection 4 of Exhibit F ". . . does not do what the regulation does which is to carve out all the preselected groups." Mr. Barengo stipulated if the last two lines in subsection 4 refer to all of section 3, then he will be in agreement with the language. Ms. Weaver commented on subsection 3. She questioned the language which states there must be doctors of homeopathy to render decisions against other doctors of homeopathy. Mr. Martin stated the goal of subsection 3, paragraph 1 is to require decisions be made by doctors within the same service. Senator Townsend pointed out unless subsection 4 and subsection 3 agree, all the contracts for insurance in the state will be changed by this language. Mr. Martin commented it is not the intent to change those relationships. He stated he requested the bill drafter to use the same language that is in the insurance division's regulations. He commented this language is not as he requested. Ms. Weaver stated subsection 2 will force an insurer to have a doctor of homeopathy make a determination of what is usual and customary. Senator Townsend directed the testifiers to discuss the intention of the bill based on Mr. Martin's provision which is to put NRS 695C into subsection 4 of Exhibit F, to have that reference to subsections 1, 2, and 3 on the previous 2 pages, to carve them, then Ms. Weaver will understand what the implication is of the language. The bill drafter will be directed to accomplish that goal and the amendment will be discussed once again. The hearing was closed at 6:15 p.m. RESPECTFULLY SUBMITTED: Molly Dondero, Committee Secretary APPROVED BY: Senator Randolph J. Townsend, Chairman DATE: Senate Committee on Commerce and Labor June 12, 1995 Page